Provider Demographics
NPI:1902196405
Name:PAHLAS MOORE, IMELDA EILEEN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:IMELDA
Middle Name:EILEEN
Last Name:PAHLAS MOORE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8325 BORON WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95828
Mailing Address - Country:US
Mailing Address - Phone:916-612-5832
Mailing Address - Fax:
Practice Address - Street 1:8325 BORON WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95828
Practice Address - Country:US
Practice Address - Phone:916-612-5832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-18
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS262041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical